Bioethical Issues in Contraception

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Transcript of Bioethical Issues in Contraception

Contraceptiveshttp://www.healthofchildren.comhttp://www.dictionary.com"The deliberate use of artificial methods or other techniques as a means to prevent pregnancy as a consequence of sexual intercourse."Contraception "To prevent pregnancy by interfering with the normal process of ovulation, fertilization, and implantation. There are different kinds of birth control that act at different points in the process."Purpose

Essentially, we don't want this:3500 years ago: Egyptian women learn how to mix dates, acacia and honey into a paste, smear it over wool and use it as a pessary to prevent conception. (They weren't the only ones.)1839: First modern rubber condoms, intrauterine devices, douching syringes and "womb veils" (all barrier devices).1873: Congress deems birth control info "obscene" and outlaws its dissemination. U.S. is the only Western nation to criminalize contraception.1880s: A large cervical cap is developed--an early version of the diaphragm, a physical barrier.1800's1916: Margaret Sanger opens America's first family-planning clinic, in Brooklyn (for 10 days).1921: Sanger founds the American Birth Control League, which later becomes the Planned Parenthood Federation of America.1930: Some bishops approve limited use of birth control; Pope Pius XI follows by affirming church teaching against contraception.1938: Federal obscenity ban on birth control is lifted, but contraception remains illegal in most states.1954: John Rock and Gregory Pincus conduct the first human Pill trial (50 women in Massachusetts).Early 1900s1960: the FDA approves Enovid, one of the first birth control pill1965: the Supreme Court strikes down state laws that prohibit contraception for married couples; 6.5 million American women are on the Pill1970: Concerns about the Pill's safety and side effects prompt Senate hearings1980s: 10.5 million American women are taking the Pill (roughly 1 in 10)Later 1900s1998: FDA approves first emergy contraceptive. (Preven pills prevent pregnancy for up to 72 hours after sex)2002-2003: 4 intra-uterine/skin-embedded contraceptive patches are developed, heralding huge advances in contraceptive technoology (NuvaRing, size of a dollar; Mirena, effective for years)2010: Studies show that women on the Pill live longer, are less likely to die prematurely of all causes (including cancer and heart disease). Some 100 million women around the world use the Pill."Deliberate prevention of conception or impregnation"Merriam-Webster DictionaryContraceptives: Then & Now!Prior to any developed methods of birth control, women had to rely on male withdrawal, and on crude infanticide and abortion for backup.The Menstrual CycleThe ETHICS of CONTRACEPTIONTypes of Contraception and Medical IssuesReligious ViewsEthics GuideThe Ethics of ContraceptionIntroductionMoral case against contraception Moral case for contraceptionDuty to use contraception?Moral Case for ContraceptionIntroduction to theContraception Debatephilosophical arguments such as the

"natural law" argumentarguments based on different ideas of marriage, sex and the familyhuman rights arguments such as'procreative liberty'a woman's right to control her own bodyhuman rights arguments about mass birth control programmesarguments based on the good or bad consequences of birth control (consequentialism)arguments about the environmental and resource problems caused by over-populationreligious argumentsMoral Case Against ContraceptionContraception is inherently wrongContraception is unnaturalContraception is anti-lifeContraception is a form of abortionContraception separates sex from reproductionContraception brings bad consequencesThese are consequentialist arguments against contraception.

Contraception carries health risksThe "contraceptive culture" is dangerousContraception prevents potential human beings being conceivedContraception prevents people who might benefit humanity from being bornContraception can be used as a eugenic toolContraception is often misused in mass population control programmes in a racist wayMass population control programmes can be a form of cultural imperialism or a misuse of powerContraception may lead to depopulationThis sounds odd to an age concerned about overpopulation but for substantial parts of the 1800s and 1900s this was a real fear.Contraception leads to "immoral behavior"Contraception makes it easier for people to have sex outside marriageContraception leads to widespread sexual immoralityContraception allows people (even married people) to have sex purely for enjoymentArguments based on life and the natural orderContraception is unnaturalthe natural consequence of having sexual intercourse is conceiving a childit is wrong to interfere with thistherefore birth-control is intrinsically wrongContraception is anti-life" life is a good thing"Contraception is a form of abortionSome birth control techniques can operate by preventing the implantation and development of a fertilized egg.Holders of this viewOpponentsthere is some purpose to the processes of the universeit is wrong to interfere with the natural order of the universethis is a religious idea rather than a secular one - most scientists regard the idea that there is a purpose to the universe as nonsensehuman beings interfere with the natural order of the universe all the time (for example when doctors cure illnesses) - sometimes the results are good and sometimes badTherefore birth control is only a wrong interference with the natural order of the universe if it produces a bad resultso it's necessary to look at the consequences of contraception to assess whether it is good or badthat is a different argument, which has nothing to do with the natural order of the universeHolders of this viewOpponentsthere is some purpose to the processes of the universethis is a religious idea rather than a secular one - most scientists regard the idea that there is a purpose to the universe as nonsenseit is wrong to interfere with the natural order of the universehuman beings interfere with the natural order of the universe all the time (for example when doctors cure illnesses) - sometimes the results are good and sometimes badTherefore birth control is only a wrong interference with the natural order of the universe if it produces a bad resultso it's necessary to look at the consequences of contraception to assess whether it is good or badthat is a different argument, which has nothing to do with the natural order of the universecontraception is morally wrong because:life is a fundamental good - it is a good thingthose who use contraception are engaged in an intentionally "anti-life" actbecause they intend to prevent a new life coming into beingthey therefore have a bad intentionit is always morally wrong to do something with a bad intentionsome birth control pillsmost modern birth control pills can prevent implantation of a fertilised egg, even though this is not the main way they workthere is no way for the user to know after any act of intercourse whether the pill prevented implantation (or worked in some other way)therefore using such pills always runs the risk of causing an abortionit is wrong to run the risk of causing an abortionthe "morning-after" pillthis is also capable of operating by preventing implantation of a fertilised eggthe IUDthis can operate by preventing implantation of a fertilised eggArguments based on sexual behaviour and healthThe danger of the "contraceptive culture"Some people are concerned that "the availability of contraceptives leads to promiscuity which then leads to abortion".Contraception carries health risksSide effectsSTDsContraception makes it easier for people to have sex outside marriageNotHuman rights benefitsit's essential for "procreative liberty"if people are not allowed a choice over whether or not to have children, their autonomy and freedom to control their lives is seriously restrictedHealth benefitsit prevents the conception of unwanted childrenand so reduces the number of possible abortionsit enables women whose health would be at risk if they conceived, to continue to have sexthe use of condoms helps prevent sexually transmitted diseases and HIVFamily benefitsit prevents the conception of children that a family cannot supportit enables people to avoid having more children than they wantit improves marriage becauseit enables couples to enjoy the unitive function of sexual activity without being anxious about conceiving a childit enables couples to have fewer children and thus spend more time together and with the children they do haveit reduces the cost of marriage (children are expensive)Benefits for womenit promotes gender equality and the autonomy of women:pregnancy and child-rearing affect women much more than menwomen should have the right to choose or avoid these activitiesany restriction of birth control is therefore sexual discriminationit promotes gender equality and the autonomy of women:it enables women to enjoy sexual activity on the same basis as menany restriction of birth control is therefore a denial of women's right to sexual autonomywithout contraception a woman may find herself having regular pregnanciesthis leads her to remain economically dependant on her partnerit enables women whose health would be at risk if they conceived, to continue to have sexDemographic benefitsenables world population to be controlled and thus protects the environment and reduces povertyNatural Family Planning and Fertility Awareness"periodic abstinence methods"no introduction of chemical or foreign material into the body or sustaining from sexual intercourse during a fertile period.

effectiveness varies greatly from 25% to 85%refraining from sexual relations ; theoretical 0% failure rate and is also the most effective way to prevent STIs ; failure rate of 85%(Cunningham et al, 2008)Calendar (Rhythm Method)requires a couple to abstain from coitus (sexual relations) on the days of a menstrual cycle when the woman is most likely to conceive (3 or 4 days before until 3 or 4 days after ovulation) to calculate “safe” days: (shortest cycle) – 18(longest cycle) – 11

- applied each week for 3 weeks; no patch applied on the4th week = menstrual flowVaginal Insertion – vaginal ring (NuvaRing)- silicone ring that surrounds the cervix and continually releases a combination of estrogen and progesterone- inserted vaginally and left in place for 3 weeks, then removed for one week (Roumen, 2007)Implantation- five subdermal implants (rods) - rods contain etonogestrel, the metabolite of desogestrel, the same progestin that is used in the NuvaRing.- Over the next 3 to 5 years, the implants slowly release the hormone, suppressing ovulation, stimulating thick cervical mucus, and changing the endometrium so that implantation is difficult.

Injection- A single intramuscular injection of medroxyprogesterone acetate (Depo-Provera [DMPA]), a progesterone, given every 12 weeks inhibits ovulation, alters the endometrium, and changes the cervical mucus> decrease in the permeability of cervical mucus --> limiting sperm motility and access to ova> interferes with tubal transport and endometrial proliferation --> possibility of implantation is significantly decreased.

INTRAUTERINE DEVICES- small plastic object that is inserted into the uterus through the vagina (Postlethwaite et al., 2007)- Copper T380 (ParaGard) and LNG-IUS (Mirena)- prevent fertilization as well as creating a local sterile inflammatory condition that prevents implantation- When copper is added to the device, sperm mobility appears to be affected as well.ChemicalMechanicalCondomsBARRIER METHODSSURGICAL PROCEDURESTYPES OF CONTRACEPTION